Haematuria and UTIs

Question 1

Give 2 drugs that can mimic visible haematuria

Answer 1

Phenazopyridine

Rifampicin

Question 2

What is the criteria for non-visible haematuria?

Answer 2

+ or more on urine dipstick, on 2+ occasions

Question 3

Which structures are responsible for initial haematuria?

Answer 3

Prostate

Anterior urethra

Question 4

Which structures are responsible midstream haematuria?

Answer 4

Structures at or above the level of the bladder

Question 5

Which structures are responsible for terminal haematuria?

Answer 5

Posterior urethra
Bladder neck
Trigone

Question 6

What is the most common cause of haematuria?

Answer 6

Urinary tract infection

Question 7

What proportion of haematuria cases are due to urinary tract malignancy?

Answer 7

10%

Question 8

What are the indications for urgent 2-week referral for suspected bladder or renal cancer?

Answer 8

Age 45+ with unexplained visible haematuria without UTI
Age 45+ with persistent visible haematuria despite successful treatment for UTI
Age 60+ with unexplained non-visible haematuria AND raised WCC or dysuria

Question 9

What is an indication for non-urgent referral for suspected bladder cancer?

Answer 9

Age 60+ with recurrent or persistent UTI

Question 10

When would you refer to nephrology for an asymptomatic patient with persistent non-visible haematuria?

Answer 10

Declining GFR
Stage 4 or 5 CKD
Under 40 with isolated haematuria and hypertension

Question 11

Apart from asymptomatic persistent non-visible haematuria, give 2 other indications for nephrology referral for patients with haematuria

Answer 11

Visible haematuria with respiratory tract infection

Aged under 16

Question 12

Give 3 indications for acute hospital admission for haematuria

Answer 12

Hypovolaemic shock
Anaemia
Current or pending clot retention

Question 13

What is the management of acute massive haematuria?

Answer 13

IV fluids and transfusion
3 way catheterisation
Irrigation with saline to prevent clot accumulation
Bladder washout to clear clots

Question 14

Which organism is the most common cause of UTIs?

Answer 14

E. coli

Question 15

What are the indications for a urine culture in suspected UTI?

Answer 15

Pregnant woman

Non-pregnant and over 65 with haematuria

Question 16

What is the first line management of UTI in non-pregnant women?

Answer 16

Trimethoprim or nitrofurantoin for 3 days

Question 17

What is the first line management of UTI in pregnant women?

Answer 17

Trimethoprim (not in first trimester), nitrofurantoin (not in last trimester), amoxicillin or cefalexin for 7 days

Question 18

What is the first line management of asymptomatic bacteruria in pregnant women?

Answer 18

Trimethoprim (avoid in 1st trimester), nitrofurantoin (avoid in 3rd trimester), amoxicillin or cefalexin for 7 days
Check post-treatment with 2nd urine culture

Question 19

What is the first line management of UTI in men?

Answer 19

Trimethoprim or nitrofurantoin for 7 days

Question 20

What is the first line management of prostatitis in men?

Answer 20

4 weeks of ciprofloxacin or ofloxacin

Question 21

What is the first line management of acute pyelonephritis (outpatient)?

Answer 21

Co-amoxiclav or ciprofloxacin

Question 22

Give 2 risks of ciprofloxacin

Answer 22

C. difficile colitis

Spontaneous tendon rupture

Question 23

What is the first line management of acute pyelonephritis (inpatient)?

Answer 23

IV gentamicin or oral cefalexin/ciprofloxacin

Question 24

What is the most common cause of chronic pyelonephritis?

Answer 24

Vesico-ureteric reflux

Question 25

How is vesico-ureteric reflux diagnosed?

Answer 25

Micturating cystography